REVERSE TOTAL SHOULDER REPLACEMENT
Total reverse shoulder replacement is very effective in treating rotator cuff tear arthropathy, as well as other conditions. It is a procedure that reverses the fixation of the prosthesis in the shoulder that was previously placed during a shoulder surgery. This is done to allow for better movement, particularly for patients with a deficient rotator cuff.
With the traditional joint replacement surgery, the Phoenix orthopedic doctor replaces the ends of the damaged humerus (upper arm bone), and sometimes, the scapula (shoulder blade) with artificial surfaces lined with either plastic or metal, or both. The shoulder joint components can be held in place with cement, so the new bone will grow into the joint component.
The purpose of the reverse total shoulder replacement procedure is to regain some function of a joint that was destroyed by rotator cuff tear arthropathy. This surgery provides stability so the deltoid muscle can function to elevate the shoulder to allow for the most basic arm mobility. This is a highly technical surgery, which is only performed by a shoulder surgeon in Phoenix with expertise in this area.
Who is a Candidate for Reverse Shoulder Replacement?
Candidates for a reverse shoulder replacement usually have rotator cuff arthropathy, severe fractures of the proximal humerus, and/or pseudo-paralysis. There is much pain and disability associated with these conditions. Rotator cuff arthroplasty is limited to patients over the age of 70, due to the decreasing survival rates, which are worsening along with implant survival.
According to the American Academy of Orthopedic Surgeons, the reverse total shoulder replacement surgery is recommended if you have:
- Rotator cuff arthropathy
- A completely torn rotator cuff
- Severe shoulder pain and trouble lifting/moving the arm
- A previous shoulder replacement that was not successful
- History of multiple conservative treatment approaches
People often have difficulties getting dressed, brushing the hair, and feeding themselves when they suffer from various shoulder afflictions. Causes of rotator cuff arthropathy include prior failed surgery for rotator cuff repair and failed shoulder replacement.
The Reverse Total Shoulder Replacement Procedure
With the reverse total shoulder replacement procedure, the patient with an arthritic shoulder has the damaged bone removed. The surgeon will smooth the ends of the bone and then attach the rounded joint piece to the shoulder bone. This is done with a cup-shaped piece that replaces the top of the upper arm bone.
While many patients benefit from this surgical approach, it is not for everyone. Success of the reverse procedure depends on the surgeon’s expertise, the patient’s health, and if the patient is an appropriate candidate.
The orthopedic surgeon in Scottsdale will use general anesthesia for the reverse shoulder replacement surgery. Sometimes, however, the patient is a candidate for regional anesthesia, so the area is numbed, but the patient remains conscious. The choice of anesthesia will depend on the surgeon and the extent of damage to the region.
The procedure itself takes 2-3 hours, with an overnight stay in the hospital common.
The typical rehabilitation schedule for a patient who has a reverse total shoulder replacement surgery is detailed and patient-specific. It often includes:
- Limited activity for six weeks – This means no shoulder movement where the muscles are concerned. You will use a pulley to lift the arm, and the shoulder should be kept flexible. The physical therapist will work with you to learn how to do these things.
- Perform specific initial exercises – These include rotating the arm to the outside, as well as elevating the shoulder region.
- Wear a sling at night – This is done to help keep the shoulder protected during recovery. Also, it is recommended that you put a small stack of folded sheets under the upper arm area while you sleep. This prevents the arm from dropping back. The sling will keep the arm secure while you sleep.
- Start strength and motion exercises – At around week six, you will begin to do strengthening exercises and stretching maneuvers to help with the rehab process. More intense exercises begin three months following the procedure.
Non-Specific and Specific Complications
Complications that can result from reverse total shoulder arthroplasty are classified into non-specific and specific complications. Non-specific complications include superficial and deep infections, phlebitis, neurological complications of the suprascapular, radial and axillary nerves, and hematomas.
Specific complications can include:
- Glenoid – Fractures of the glenoid baseplate, intraoperative fracture of the glenoid and acromion, impingement at the scapular neck (notching), dissociation of the glenoid component, or the snatching of the glenosphere or glenoid loosening.
- Humeral – Instability of the shoulder, metaphyseal deterioration, stiffness with external and or internal rotation, and humeral loosening.
- Muscular – Complication with the fatty degeneration of the deltoid. Specific situations have been identified and these are the dissociation of the metaphysis, disassembly of the humeral or the glenoid component and osteolysis of the tuberosities, which are all related to the type of implant that was used.
Overall, complications are uncommon but not rare. Outcomes with reverse total shoulder replacement have been exceptional for patients with regards to pain relief and shoulder functional improvement.
Dr. Sumit Dewanjee is a Phoenix shoulder surgeon with extensive experience in the procedure. If you or a loved one is suffering from shoulder pain, call FXRX for an evaluation today!